PDF(Pubmed)
Abstract：
UNASSIGNED: Despite modern radiotherapy (RT) techniques, radiation-induced proctitis (RIP) remains a significant complication of RT for pelvic organ malignancies. Over the last decades, an enormous therapeutic armamentarium has been considered in RIP, including hyperbaric oxygen therapy (HBOT). However, the evidence regarding the impact of HBOT on RIP is conflicting. This study aims to evaluate the effectiveness and safety of HBOT in the treatment of RIP.
UNASSIGNED: Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital - Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first-class hyperbaric chamber, for 70-min periods, once daily, five times per week. Fisher\'s exact test was performed using SPSS (version 23.0); p<0.05 was accepted as statistically significant.
UNASSIGNED: Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumor treated with RT was prostate cancer (77.3%), followed by cervical cancer (10.2%). Hematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a hematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses require fewer than 70 sessions of HBOT in terms of overall RIP symptoms (p=0.069), isolated hematochezia tends to require at least 70 sessions (p=0.075). Individuals with at least two concurrent late radiation tissue injuries were associated with a complete response to HBOT (p=0.029). Only about 5.7% of patients did not respond to the treatment. Eighteen patients (20.5%) developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047).
UNASSIGNED: The HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.
UNASSIGNED: Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital - Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first-class hyperbaric chamber, for 70-min periods, once daily, five times per week. Fisher\'s exact test was performed using SPSS (version 23.0); p<0.05 was accepted as statistically significant.
UNASSIGNED: Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumor treated with RT was prostate cancer (77.3%), followed by cervical cancer (10.2%). Hematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a hematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses require fewer than 70 sessions of HBOT in terms of overall RIP symptoms (p=0.069), isolated hematochezia tends to require at least 70 sessions (p=0.075). Individuals with at least two concurrent late radiation tissue injuries were associated with a complete response to HBOT (p=0.029). Only about 5.7% of patients did not respond to the treatment. Eighteen patients (20.5%) developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047).
UNASSIGNED: The HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.
摘要：
■尽管采用了现代放射治疗（RT）技术，放射性直肠炎（RIP）仍然是RT治疗盆腔器官恶性肿瘤的重要并发症。在过去的几十年里，在RIP中考虑了一个巨大的治疗性武器库，包括高压氧治疗（HBOT）。然而,关于HBOT对RIP影响的证据是相互矛盾的。本研究旨在评估HBOT治疗RIP的有效性和安全性。
■10年（2013-2023年）回顾性分析所有在美国医学中心（CMSH）接受HBOT治疗的RIP连续患者（武装部队医院-里斯本，葡萄牙)。患者在2.5ATA下暴露于100%氧气，在多地一级高压舱中，70分钟，每天一次,每周五次。使用SPSS（23.0版）进行Fisher精确检验；p<0.05被认为具有统计学意义。
■在总共151名RIP患者中，88人被纳入最终分析，其中38.6％的人同时出现其他辐射引起的软组织病变。接受RT治疗的最多报告的原发性盆腔肿瘤是前列腺癌（77.3％），其次是宫颈癌(10.2%)。便血是最常见的临床表现(86.4%)。经过60个HBOT会话的中位数（四分位数范围[IQR]：40-87.5），62.5%和31.8%的患者实现了临床完全和部分缓解，分别,便血消退率为93.7％（完全或部分）。虽然部分和完全反应需要少于70个疗程的HBOT在整体RIP症状方面（p=0.069），孤立性便血倾向于至少需要70个疗程(p=0.075)。患有至少两次并发晚期放射组织损伤的个体与对HBOT的完全反应相关（p=0.029）。只有约5.7%的患者对治疗没有反应。18例患者（20.5％）发生了可逆性耳气压伤。HBOT会话的数量是HBOT副作用的预测因子(比值比：1.010；95%置信区间，1.000-1.020；p=0.047）。
■HBOT被证明是对医学和/或内窥镜治疗难治性RIP的有效且安全的治疗方法。这项真实世界的证据研究为使用HBOT管理RIP的已发布数据增加了价值。
■10年（2013-2023年）回顾性分析所有在美国医学中心（CMSH）接受HBOT治疗的RIP连续患者（武装部队医院-里斯本，葡萄牙)。患者在2.5ATA下暴露于100%氧气，在多地一级高压舱中，70分钟，每天一次,每周五次。使用SPSS（23.0版）进行Fisher精确检验；p<0.05被认为具有统计学意义。
■在总共151名RIP患者中，88人被纳入最终分析，其中38.6％的人同时出现其他辐射引起的软组织病变。接受RT治疗的最多报告的原发性盆腔肿瘤是前列腺癌（77.3％），其次是宫颈癌(10.2%)。便血是最常见的临床表现(86.4%)。经过60个HBOT会话的中位数（四分位数范围[IQR]：40-87.5），62.5%和31.8%的患者实现了临床完全和部分缓解，分别,便血消退率为93.7％（完全或部分）。虽然部分和完全反应需要少于70个疗程的HBOT在整体RIP症状方面（p=0.069），孤立性便血倾向于至少需要70个疗程(p=0.075)。患有至少两次并发晚期放射组织损伤的个体与对HBOT的完全反应相关（p=0.029）。只有约5.7%的患者对治疗没有反应。18例患者（20.5％）发生了可逆性耳气压伤。HBOT会话的数量是HBOT副作用的预测因子(比值比：1.010；95%置信区间，1.000-1.020；p=0.047）。
■HBOT被证明是对医学和/或内窥镜治疗难治性RIP的有效且安全的治疗方法。这项真实世界的证据研究为使用HBOT管理RIP的已发布数据增加了价值。
